Impact of COVID vaccination rollout on the use of computed tomography venography for the assessment of cerebral venous sinus thrombosis.

INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is rare; however, it has been observed in patients with vaccine-induced immune thrombotic thrombocytopaenia syndrome (VITT) following the use of adenovirus vector vaccines against COVID-19. Adverse vaccine effects have been heavily addressed in mainstream media, likely contributing to vaccination anxiety. This study aimed to assess how the vaccine rollout and media coverage has influenced the use of computed tomography venography (CTV) in an acute care setting of a tertiary hospital. METHOD: Single-centre retrospective cohort study from 30 March 2021 to 13 June 2021. Direct comparison to same calendar dates in the preceding 3 years. RESULTS: In 2021, 57 patients received CTV with headache being the reason in 48 (84%) and 40 (70%) had received ChAdOx1 nCov-19 (AstraZeneca COVID-19 vaccination). Only 20 of these patients received CTV after platelets and D-Dimer had returned, and only three patients met existing guidelines for imaging. Zero cases were positive. The number of CTV studies was 5.2 times than in 2020 and 2.7 times the mean number for the 3 preceding years. CONCLUSION: The use of CTV in patients with headache has markedly increased at our centre since negatively biased vaccination influence of mainstream media. Headache is a common vaccine-related side effect and VITT is exceptionably rare. With the rates of vaccination increasing in the community, these results highlight the importance of strict adherence to established evidence-based guidelines. Otherwise, critical care capacity, and in particular imaging resources already under pressure will be strained further.

Radiological assessment of facial fractures: a comparative study between surgeon and radiologist.

BACKGROUND: The authors aimed to examine the differences in CT facial bone interpretation by the faciomaxillary surgeon and the radiologist, in order to improve communication gaps and subsequently, the quality and consistency of patient care. METHODS: This study was conducted at a level I tertiary trauma centre. Patients with facial trauma who were referred to the faciomaxillary unit following a facial CT examination from August 2017 to September 2018 were eligible for inclusion. The inclusion period was extended to 5 years for panfacial trauma patients. All consecutive patients that fulfilled the study inclusion criteria for each type of injury were included in the study (a total of 120 patients assigned to the following six categories: orbits, skull and skull base, zygomaticomaxillary complex, Le Fort pattern, mandible and pan-facial fractures). Faciomaxillary surgeons, blinded to the radiology report, were asked to provide a verbal description of the fractures. The surgical interpretation was compared to the radiology report and further analysed. RESULTS: Of the 120 cases, the same fractures were reported in 43 cases (35.8%). Both types of specialists noted the predominant and clinically relevant fractures in 106 cases (88.3%). The reports did not match in 14 cases (11.7%) and different terminology was used in 76 cases (63.3%), with agreement in 25% (95% CI: 18-34%), partial agreement in 11.7% (95% CI: 5.9-17.4%) and no agreement in 63.3% (95% CI: 54.7-72.0%) cases. CONCLUSION: Radiologists and faciomaxillary surgeons frequently differ in their assessment of facial fractures.

A comparison of radiostereometric analysis and computed tomography for the assessment of lumbar spinal fusion in a sheep model.

Study Design Prospective animal study. Objective The aim of this animal study is to evaluate the accuracy of radiostereometric analysis (RSA) compared with computed tomographic (CT) scan in the assessment of spinal fusion after anterior lumbar interbody fusion (ALIF) using histology as a gold standard. Methods Three non-adjacent ALIFs (L1-L2, L3-L4, and L5-L6) were performed in nine sheep. The sheep were divided into three groups of three sheep. All the animals were humanely killed immediately after having the last scheduled RSA. The lumbar spine was removed and in vitro fine cut CT and histopathology were performed. Results Using histological assessment as the gold standard for assessing fusion, RSA demonstrated better results (100% sensitivity and 66.7% specificity; positive predictive value [PPV] = 27.3%, negative predictive value [NPV] =100.0%) compared with CT (66.7% sensitivity and 60.0% specificity [PPV = 16.7%, NPV = 93.8%]). Conclusions RSA demonstrated higher sensitivity and specificity when compared with CT. Furthermore, RSA has the advantage of much lower radiation exposure compared with fine cut CT. Further studies are required to see if RSA remains superior to CT scan for the assessment spinal fusion in the clinical setting. [Table: see text].

Assessing potential spinal injury in the intubated multitrauma patient: does MRI add value?

The purpose of the study was to determine the role of magnetic resonance imaging (MRI) in intubated multitrauma patients with normal computed tomography (CT) in excluding unstable ligamentous injury to the cervical spine. A retrospective evaluation was done on those multitrauma patients admitted to the intensive care unit of a level 1 trauma centre who had normal single-slice helical CT cervical spine and underwent MRI for cervical spine clearance from 1/1/04 to 30/6/05. Fifty-five patients met the inclusion criteria. Ten of these patients had a discoligamentous injury identified on MRI; however, all these patients had injuries limited to only one of the three columns of the cervical spine. Single-slice helical CT with sagittal reformats had a negative predictive value of 82% for discoligamentous injury and 100% for unstable injury. A normal single-slice helical CT with sagittal reformats of the cervical spine in intubated trauma patients excluded unstable injuries at follow-up cervical spine MR imaging.